Barriers & facilitators to physical activity in people with depression and type 2 diabetes mellitus in Pakistan: A qualitative study to explore perspectives of patient participants, carers and healthcare staff

Background: The health benefits of physical activity in adults with depression and type 2 diabetes mellitus (T2DM) are well established, however people with depression and T2DM do not generally reach recommended levels of physical activity. Evidence on how to support physical activity in this group is limited; this is particularly the case in low- and middle-income countries. To develop interventions to promote physical activity, it is important first to understand the barriers and facilitators in this population. Methods: A qualitative study was conducted in Pakistan using semi-structured individual interviews. Adults diagnosed with depression and T2DM, their carers, and healthcare staff were included. Interviews were audiorecorded and transcribed verbatim. Inductive thematic analysis was used to identify themes. Results: Twenty-three participants (12 male; 11 female) were recruited. Five themes were generated from the data: 1) Cultural and religious norms and practices influence physical activity behaviours 2) Availability of resources and the potential for incorporating physical activity into routine life determine physical activity behaviours 3) Available healthcare resources can be used to promote physical activity 4) Patients' individual-level characteristics affect their physical activity behaviours 5) Technology-based interventions may be used to promote physical activity. Conclusion: Individual, cultural, and healthcare system level barriers and facilitators can affect the participation of people with depression and T2DM in physical activity. Religious, social, cultural, domestic, and occupational activities provide opportunities to perform physical activities. Furthermore, harnessing routinely available healthcare resources and the use of technology-based interventions can facilitate the promotion of physical activity.